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In 2012, we reviewed the adherence to the Clinical Practice Guidelines for services received
in 2011 among members enrolled in AmeriHealth New Jersey plans. All measures
were collected through the National Committee for Quality Assurance (NCQA)
Healthcare Effectiveness Data and Information Set (HEDIS?) data. The study results are listed below for
diabetic and cardiac services.
Diabetic service results
AmeriHealth
New Jersey (commercial)
- Screening for retinal eye
examinations for diabetic members decreased slightly between 2010 and 2011 (49%
to 48%). The rate remains low, representing an opportunity for improvement.
- HbA1c testing for diabetic
members remained flat between 2010 and 2011 (86% to 86%); however, the rate for
members with HbA1c Poor Control (79%) has improved significantly from 42% to
30% (lower is better), and the rate of members with HbA1c Control (<8.0%)
also improved significantly from 54% to 61%. The rate of members with HbA1c
Control (<7.0%) has remained flat at 38%. The rate represents an opportunity
for improvement.
- LDL-C screening for diabetic
members decreased slightly between 2010 and 2011 (84% to 83%); however, the
decrease was not significant. There was an increase in diabetic members who had
an LDL cholesterol level of less than 100. This rate increased from 42% to 45%.
The low rate represents an opportunity for improvement.
- 79% of diabetic members
received medical attention for nephropathy in 2010 and 2011.
AmeriHealth 65? NJ HMO
(Medicare Advantage)
- Screening for retinal eye
examinations for diabetic members increased significantly between 2010 and 2011
(60% to 73%).
- HbA1c testing for diabetic
members improved between 2010 and 2011 (88% to 92%). The rate for members with
HbA1c Poor Control (>9.0%) has improved significantly from 25% to 14% (lower
is better), and the rate of members with HbA1c Good Control (<8.0%) improved
significantly from 69% to 79%.
- LDL-C screening for diabetic
members decreased slightly between 2010 and 2011 (90% to 89%). There was an
increase in diabetic members who had an LDL cholesterol level of less than 100.
This rate increased from 57% to 58%. The low rate represents an opportunity for
improvement.
- Diabetic members receiving
medical attention for nephropathy decreased between 2010 and 2011
(88% to
86%).
Cardiac service results
AmeriHealth New Jersey
(commercial)
- Blood pressure control for
hypertensive members increased slightly between 2010 and 2011 (64% to 66%). The
low rate represents an opportunity for improvement.
- LDL-C screening for
members with cardiovascular conditions increased significantly between 2010 and
2011 (85% to 91%). There was also an increase in members who had an LDL
cholesterol level less than 100. This rate increased from 61% to 67% but still
represents an opportunity for improvement.
AmeriHealth 65? NJ HMO
(Medicare Advantage)
- Blood pressure control for
hypertensive members increased significantly between 2010 and 2011 (61% to
73%).
- LDL-C screening for
members with cardiovascular conditions remained flat between 2010 and 2011 (93%
to 93%). There was an increase in members who had an LDL cholesterol level of
less than 100. This rate increased from 71% to 73%.
Continued outreach
We will continue to provide educational
outreach for members who have diabetes and cardiovascular conditions through
the ConnectionsSM Health Management Program,
targeted mailings, and member Update
magazine. Clinical Practice Guidelines and
medical record standards will continue to be reviewed, revised, and distributed
to practitioners on an annual basis and made available at www.amerihealth.com/providerconnections.
Information about the Connections
Health Management Program is available at www.amerihealth.com/providerconnections or by calling the
Connections Provider Support Line at 1-866-866-4964.